Answer: Separate the staffing commitment from the case activity within it and the billable units generated. An anesthesia executive calls room staffing a capacity cost: a provider covers the room throughout its coverage day regardless of case volume. A practice management executive says productivity comparisons also need to account for call, nonoperating room coverage, and medical direction.
The short answer
For your hospital discussion, keep coverage capacity and case activity visible as separate parts of the explanation. A room finishing its cases does not, by itself, explain the staffing commitment. The anesthesia executive's point is that staffing a room throughout its coverage day carries a cost regardless of how many cases it handles.
Billable time units add another view, but they do not capture every responsibility. The practice management executive says providers can generate different billable activity because their assignments include different shares of call, nonoperating room coverage, and medical direction. Those responsibilities belong in the productivity discussion alongside billable time units.
What usually goes wrong
One problem is treating billable time units as the complete measure of contribution. The practice management executive explains that providers with different assignments can contribute through responsibilities that a comparison of those units alone misses.
Another problem is leaving nonoperating room activity out of utilization reporting. The same executive says these cases are spread across hospital locations. Scheduling may be disconnected, and electronic records may be incomplete. Excluding this activity can make operating room utilization reports overstate efficiency.
Coverage commitments can also reflect expected growth. Academic authors report that their institution established full day coverage for new nonoperating room services in anticipation of greater volume. When that growth did not occur, coverage could exceed clinical need.
What a veteran checks first
- The distinction between room staffing capacity and case volume.
- Call, nonoperating room coverage, and medical direction responsibilities represented in a productivity comparison.
- Whether utilization reporting includes nonoperating room activity.
- The anticipated growth underlying full day coverage for new services.
- The collection and compensation assumptions underlying a modeled production requirement.
- The relationship between provider availability and operating room scheduling.
What the experience shows
An anesthesia executive characterizes anesthesia as a capacity cost because room coverage requires a provider throughout the coverage day regardless of case volume. That is the central distinction when explaining the staffing commitment alongside the activity within it.
Academic authors report that their institution aligned nonoperating room coverage hours with nursing shifts under hospital policy. They also report that full day schedules established for anticipated growth could exceed clinical need. Their account concerns scheduling at their institution.
A practice management executive includes call, nonoperating room coverage, and medical direction in productivity comparisons. The executive also points to missing nonoperating room activity as a reason utilization reports can overstate efficiency.
A production estimate depends on the practice's staffing, net collections per unit and compensation assumptions.
An anesthesia leader says groups with varying provider numbers must coordinate provider availability with operating room scheduling to determine how many rooms they can cover. The leader also identifies consistent provider numbers as important to operating room efficiency.
Questions to bring to the partner meeting
- How does our discussion distinguish coverage capacity from case activity?
- How are call, nonoperating room coverage, and medical direction represented?
- Does our utilization report include nonoperating room activity?
- Which coverage schedules reflect anticipated growth?
- What collection and compensation assumptions underlie a production estimate?
- How does provider availability relate to the operating room schedule?
Sources
- Adam Spiegel, CEO of NorthStar Anesthesia
- CCI Anesthesia leader
- Jody Locke, MA
- Justin S. Routman, Erik J. Zhang, Jonathan D. Blocker et al.
- Robert M. Johnson, RCPT, MBA
